The Use of the Oxygenated Airdrive^TM Machine Perfusion System in Kidney Graft Preservation: A Clinical Pilot Study

Abstract

Background: The shortage of donor kidneys has led to the use of marginal donors, e.g., those whose kidneys are donated after circulatory death. Preservation of the graft by hypothermic machine perfusion (HMP) provides a viable solution to reduce warm ischemic damage. This pilot study was undertaken to assess the feasibility and patient safety of the AirdriveTM HMP system in clinical kidney transplantation. Methods: Five deceased-donor kidneys were preserved using the oxygenated Airdrive HMP system between arrival at the recipient center (Amsterdam UMC) and implantation in the patient. The main study end-points were adverse effects due to the use of Airdrive HMP. Secondary end-points were clinical outcomes and perfusion parameters. All events occurring during the transplantation procedure or within 1 month of follow-up were monitored. Results: Five patients were included in this pilot study. No technical failures were observed during the preservation period using the Airdrive HMP. Mean perfusion parameters were: duration 8.5 h (3–15 h), pressure 25 mm Hg (18–25 mm Hg), flow 49.77 mL/min (19–58 mL/min), resistance 0.57 mm Hg/min/mL (0.34–1.3 mm Hg/min/mL), and temperature 8.2 °C (2–13°C). Mean cold ischemia time (CIT) was 20.2 h (11–29.5 h). No adverse events or technical failures were observed during preservation and transplantation or during the 1-month follow-up. Conclusions: This pilot study showed the feasibility of the use of the Airdrive HMP system with no adverse events in clinical kidney transplantation.

Outcomes of Kidney Perfusion Techniques in Transplantation from Deceased Donors: A Systematic Review and Meta-Analysis

“…Authors’ judgments about each risk-of-bias item as percentages among all included HMP vs. SCS studies; Supplementary Figure S3: Risk-of-bias graph and summary table. Authors’ judgments about each risk-of-bias item as percentages among all included HMP + O 2 vs. SCS studies [ 12 , 19 , 23 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 58 , 59 , 60 , 61 , 67 , 68 , 72 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , ...…”

Current Evidence and Future Perspectives to Implement Continuous and End-Ischemic Use of Normothermic and Oxygenated Hypothermic Machine Perfusion in Clinical Practice

“…Currently, six clinical trials studied the effect of active oxygenation during HMP with a variety of O 2 administration strategies, as detailed in Table 1 [63,65,66,[78][79][80]. The strongest evidence for active oxygenation during HMP is derived from the multicenter randomized controlled trial (RCT) including 50 years or older DCD Maastricht category III donors.…”

Simply Adding Oxygen during Hypothermic Machine Perfusion to Combat the Negative Effects of Ischemia-Reperfusion Injury: Fundamentals and Current Evidence for Kidneys

“…Via open venous drainage, the perfusion fluid is collected into the reservoir of the organ chamber and again pumped towards the membrane oxygenator to reoxygenate the perfusion fluid. The oxygenated Airdrive HMP system (Doorzand, Amsterdam, The Netherlands) is a new portable, disposable device and perfuses the organ by means of an oxygen pressuredriven membrane pump [48]. A hollow fiber membrane oxygenator in the machine perfusion circuit allows for active oxygenation of the preservation solution to achieve partial oxygen pressure (pO 2 ) of at least 80-100 kPa (600-750 mmHg) [49][50][51].…”

“…The experience of active oxygenation during HMP is currently limited to five clinical trials, with a variety of oxygen preservation strategies, detailed in Table 2 [47,48,50,51,77]. Data are presented as median (range), except *.…”